Provider Demographics
NPI:1144434895
Name:LUEDTKE, PIA LINDSTROM (MD)
Entity type:Individual
Prefix:DR
First Name:PIA
Middle Name:LINDSTROM
Last Name:LUEDTKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N 1ST AVE
Mailing Address - Street 2:#201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7027
Mailing Address - Country:US
Mailing Address - Phone:626-698-7246
Mailing Address - Fax:
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:HUNTINGTON MEMORIAL HOSPITAL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA904072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154310415OtherBLUE SHIELD
CA1154310415OtherBLUE CROSS
CACF017ZMedicare PIN
CA1154310415OtherBLUE SHIELD
CACF017YMedicare PIN
CA1154310415OtherBLUE CROSS
CACF017WMedicare PIN
CACF017XMedicare PIN